Patients
Cochrane review «Jongstra S, Harrison JK, Quinn TJ ym. Antihyperten...»1 included two randomised controlled trials (3 papers) investigating withdrawal of antihypertensives in 2490 participants aged 18 years and over. Participants must have been taking the antihypertensive medications for a minimum of one month irrespective of indication and they could reside in any healthcare setting (including acute hospitals, nursing and residential homes, and the community). The study included healthy participants and participants with all grades of severity of existing dementia or cognitive impairment.
Intervention
Withdrawal (complete or partial) of any medication with blood pressure lowering effects with no restriction to duration of follow-up.
Comparison
Continuing antihypertensive treatment.
Outcomes
Primary outcomes: 1) Cognitive impairment or rates of incident dementia in cognitively intact and cognitively impaired adults and 2) Cognition in the short-term in adults with or without established cognitive impairment.
In review's one study, the Mini-Mental Examination test (t-MMSE) score was a mean of 1.0 point higher after an acute stroke in hospital setting in participants (mean age 73 years) who withdrew antihypertensive medications compared to participants who continued them (95% confidence interval (CI) 0.35 to 1.65; 1784 participants) and the Telephone Interview for Cognitive Status (TICS-M) was a mean of 2.10 points higher (95% Cl 0.69 to 3.51; 1784 participants). In both cases the evidence was of very low quality downgraded due to risk of bias, indirectness and evidence from a single study. The duration of antihypertensive withdrawal was seven days.
In the other study, in which the participants (mean age of 81 years) had mild cognitive impairment, the cognitive performance was assessed using a composite of at least five out of six cognitive tests. there was no evidence of a difference comparing participants who withdrew antihypertensive medications and participants who continued (mean difference 0.02 points, 95% CI -0.19 to 0.21; 351 participants). The study was conducted in primary care in the Leiden region of the Netherlands. This evidence was of low quality and was downgraded due to risk of bias and evidence from single study.